Commentary: Believe in a broader use of statins

September is National Cholesterol Education Month, and it’s time that people take the necessary steps to prevent and treat one of the main risk factors for heart disease and stroke.

Recently, the American College of Cardiology and the American Heart Assn. presented new guidelines for the prevention of heart attack and stroke that greatly widen the number of people who could benefit from statin therapy. Statins are a class of medications that mainly reduce the levels of cholesterol in the blood.

The new guidelines, which replace 11-year-old recommendations, were met with immediate skepticism. While previous guidelines supported using statins for secondary prevention of heart disease in men, the new guidelines suggest statins are effective for both primary and secondary prevention in patients of both sexes and all ages, and that they are more effective for those with higher risk factors.

The guidelines also discourage combination therapy because the additional value of agents other than statins has not been established.

I attended the presentation in Dallas and, like many people, was wary at first. But the science is convincing: The guidelines were generated by a great number of scientists and experts in the field who reviewed the most recent literature and hard outcomes of randomized clinical trials and meta-analyses of random clinical trials.

So if your doctor uses the new guidelines to give you medication, it is because your risk of developing a heart attack or stroke in the next 10 years is high.

The new guidelines identify four types of people who would best benefit from moderate- or high-intensity statin therapy:

1.) People with atherosclerotic cardiovascular disease.

2.) People with LDL, or “bad,” cholesterol levels over 190 mg/dL.

3.) People ages 40 to 75 who have either Type 1 or Type 2 diabetes and LDL levels over 70 who don’t have atherosclerotic cardiovascular disease.

4.) People ages 40 to 75 who have neither atherosclerotic cardiovascular disease or diabetes, but who have LDL levels over 70 and an estimated 10-year risk of the cardiovascular disease of 7.5% or higher (see risk calculator at https://www.heart.org.

These new guidelines might result in more people being put on statins, but they will also help ensure that those people will benefit from the drug. And for the first time, African Americans, women and Hispanics are represented in the guidelines.

Also, previous guidelines recommended that doctors focus on bringing bad cholesterol numbers down. The new recommendations de-emphasize the numbers and instead suggest treating the individual intensely.

Not only should at-risk people receive statins, they often need to overhaul their diet and exercise routines.

In my practice, I recommend sticking to a Mediterranean diet — rich in fish, nuts, olive oil, vegetables and fruit — which has been shown to reduce cardiovascular events by 70% and cancer by 60%.

Since I have begun using the new guidelines in my practice, I expected some resistance. After all, I was now telling patients they needed medications that were not previously recommended for them. So far, though, the reception has been positive.

Dr. BAHRAM ESLAMI is a cardiologist and director of cardiovascular services at Hoag Hospital.